ASPRE trial: effects of aspirin on mean arterial blood pressure and uterine artery pulsatility index trajectories in pregnancy

Author:

Rolnik D. L.1ORCID,Syngelaki A.2ORCID,O'Gorman N.3,Wright D.4,Poon L. C.5ORCID,Nicolaides K. H.2

Affiliation:

1. Department of Obstetrics and Gynaecology Monash University Melbourne Australia

2. Fetal Medicine Research Institute King's College Hospital London UK

3. Coombe Women and Infants University Hospital Dublin Ireland

4. Institute of Health Research University of Exeter Exeter UK

5. Department of Obstetrics and Gynecology The Chinese University of Hong Kong Hong Kong SAR

Abstract

ABSTRACTObjectivesThe mechanism by which aspirin prevents pre‐eclampsia is poorly understood, and its effects on biomarkers throughout pregnancy are unknown. We aimed to investigate the effects of aspirin on mean arterial pressure (MAP) and mean uterine artery pulsatility index (UtA‐PI) using repeated measures from women at increased risk of preterm pre‐eclampsia.MethodsThis was a longitudinal secondary analysis of the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence‐Based Pre‐eclampsia Prevention (ASPRE) trial using repeated measures of MAP and UtA‐PI. In the trial, 1620 women at increased risk of preterm pre‐eclampsia were identified using the Fetal Medicine Foundation algorithm at 11 + 0 to 13 + 6 weeks, of whom 798 were randomly assigned to receive 150 mg/day aspirin and 822 were assigned to receive placebo daily from 11–14 weeks to 36 weeks of gestation or delivery, whichever came first. MAP and UtA‐PI were measured at baseline and follow‐up visits at 19–24, 32–34 and 36 weeks of gestation. Generalized additive mixed models with treatment by gestational age interaction terms were used to investigate the effects of aspirin on MAP and UtA‐PI trajectories over time.ResultsAmong 798 participants in the aspirin group and 822 in the placebo group, there were 5951 MAP and 5942 UtA‐PI measurements. Trajectories of raw and multiples of the median (MoM) values of MAP did not differ significantly between the two groups (MAP MoM analysis: P‐value for treatment by gestational age interaction, 0.340). In contrast, trajectories of raw and MoM values of UtA‐PI showed a significantly steeper decline in the aspirin group than in the placebo group, with the difference mainly driven by a more pronounced reduction before 20 weeks of gestation (UtA‐PI MoM analysis: P‐value for treatment by gestational age interaction, 0.006).ConclusionsIn women at increased risk of preterm pre‐eclampsia, 150 mg/day aspirin initiated in the first trimester does not affect MAP but is associated with a significant decrease in mean UtA‐PI, particularly before 20 weeks of gestation. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Funder

Fetal Medicine Foundation

FP7 Health

Publisher

Wiley

Subject

Obstetrics and Gynecology,Radiology, Nuclear Medicine and imaging,Reproductive Medicine,General Medicine,Radiological and Ultrasound Technology

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